Growing up, my frequent worrying was beyond normal childhood anxieties. I couldn’t wear green shirts, I had to use the same fork at dinner each night, and I read Bible chapters to prevent bad things from happening.

While my parents were aware that for a time, I worried excessively about bad things happening, they never assumed it might be obsessive-compulsive disorder (OCD). In their eyes, OCD meant repeated hand washing or unusual physical rituals, but not worrying.

They reassured me in every way possible that nobody was going to die. But that didn’t make my extreme anxiety — or my behaviors — go away. As I got older and became ashamed of my behaviors, I hid my distress. My parents naturally assumed I had outgrown what was just a regular phase of childhood.

Meanwhile, my worrying became even worse. I declined offers to visit friends because I didn’t want my parents to die driving me there. I avoided music with lyrics that suggested death. I obsessed over what time my parents were supposed to pick me up, for fear that something had happened to them on the way.

It turns out, I, like approximately 1 to 3 percent of children and adolescents, had one of the more common mental illnesses among children: OCD. Considered an anxiety disorder, OCD is marked by obsessive thoughts. Compulsions, or repetitive behaviors, are then used to regulate or ease the obsessive thoughts. The result is a series of symptoms that can be disruptive to a child’s emotional well-being and ability to function.

If you suspect your child may have OCD, watch for these five warning signs and learn what you can do to help.

Classic potential signs of OCD include repetitive rituals, routines, and checking. Look for unusual or particular patterns, especially ones that preoccupy the child or cause distress.

For example, a child may check to make sure all household appliances are turned off before they go to bed. If they miss checking one, they might have to start the routine over. They may dislike certain numbers or have to count items or tap specific patterns repeatedly. They may avoid certain clothing or be particular about the order in which they put on their clothing. Children may avoid germs and wash obsessively. Or, they may want to resist touching “dirty” parts of their body, stop tying their shoes, or stop washing their hair.

Many children want their parents to say goodnight in a certain way or like their stuffed animals lined up in a specific order. That doesn’t mean they have OCD. This only becomes problematic when a child is obsessed with their routines and they get upset if their checking or rituals are interrupted. Children may also spend more and more time on their OCD behaviors, which can interfere with their ability to function.

“It’s normal for a child to want to wash their hands after getting them dirty,” says Crystal I. Lee, a licensed psychologist in Los Angeles. “It’s concerning if the hand washing happens too often, for abnormally long periods of time, or if the child gets extremely upset when they can’t wash their hands when they think they need to. It’s also concerning if their hand washing behavior or their concern about getting dirty starts interfering with them participating in school [and] playing with peers.”

Another sign a child may be struggling with OCD is parental involvement in rituals and routines. Children can’t regulate the scary emotions OCD brings up on their own, and they often need parents to participate. For example, a child may insist a parent tuck them into bed a certain way, or help them check all the locks on the doors.

“Children rely on the parent to manage OCD for them,” says Debra Green, a licensed marriage and family therapist. “If the parent doesn’t do what the child wants, the child becomes very distressed.”

According to Green, “If you find as a parent that you’re managing your child’s anxiety by following their rituals, your child may be struggling with more than normal childhood worries.”

Children may experience thoughts about bad things happening to themselves or loved ones, or them causing harm to someone else. While repetitive behaviors are easy to recognize, unless a child reports worrisome thoughts, they can’t be observed as easily.

Lee recommends openly talking with anxious children about their fears.

“Children with OCD are often very ashamed and embarrassed of their behavior, so it’s important for parents to gently, lovingly, and empathetically speak with their children about their suspicion,” Lee says. “It can help to externalize the issue, such as calling OCD a ‘worry monster’ that the child may need help tackling.”

Angry outbursts and behavioral problems can be linked to many childhood issues, including OCD. OCD can be distressing, shameful, and disruptive for children. They’re dealing with scary thoughts and overwhelming emotions without the tools to make sense of them alone. Children may act out as a result.

“At times, if a child has OCD they might have anger outbursts — oftentimes at home when things aren’t done in a particular way,” says Shawn Ewbank, a licensed psychologist at the Mind Health Institute in Santa Monica, California. “Sometimes when a child is having behavioral problems, OCD might be one of many reasons why something might be going on.”

If you’re concerned your child could have OCD, it may be time to see a professional. Experts recommend taking the child to see their family doctor or consulting a mental health professional, who will likely recommend a full psychological assessment. The earlier you catch childhood OCD, in general, the easier it is to manage.

If a child is diagnosed with OCD, treatment may include therapy, such as cognitive behavioral therapy (CBT). CBT helps children develop coping skills to manage obsessions and compulsions. These skills give a child the tools they need to regulate their anxiety and lessen the grip of OCD. A psychiatrist may recommend medication as well.

OCD is stressful for both children and their families. Green recommends “being supportive and recognizing that this is not the child’s fault, they’re not choosing to do this. This is something that, in their brain, that they’re really struggling with.”

In today’s parenting culture, where there’s a tendency to over-diagnose normal childhood behaviors, my parents may have reacted to my worrying differently. However, it took me nearly 20 years to understand my OCD and learn it was a disorder that could be treated. It took education, professional help, and a lot of loving support to overcome my OCD.